Croup and epiglottitis: A radiologic study

Abstract

Because of the controversy regarding the benefits of the lateral neck and chest radiographs in the evaluation of croup and epiglottitis, a two-part retrospective study was initiated. Part I consisted of a retrospective chart review of 44 patients with a final diagnosis of croup and epiglottitis. Part II consisted of the 42 lateral neck and chest x-rays from patients in part I presented to six radiologists who knew only the patients age and the history of respiratory distress. Two hundred forty-six responses were obtained. The results of the part I study showed that 64% of patients with documented epiglottitis had a positive radiologic diagnosis. Only 33% of patients with croup had a positive radiologic diagnosis and importantly 27% had a diagnosis of possible epiglottitis. The results of part II showed 38% of the documented epiglottitis patients had a positive lateral neck radiograph. The croup patients had a lateral neck and/or chest x-ray positive in 38%. Of interest, 24% had readings consistent with possible epiglottitis. Based on this two-part study, it is our conclusion that the lateral neck and chest x-ray may be unreliable and inaccurate in the diagnosis of croup and epiglottitis. Caution and good clinical judgement should be utilized when interpreting these x-rays.

Clinical features of patients with acute epiglottitis in the emergency department

“…Several studies have revealed that sore throat was the commonest presenting complaint. 4,[6][7][8][9][10][11] However, this complaint was nonspecific and commonly expressed by patients with other disease entities. By contrast, odynophagia was more specific to patients with AE and was less often reported in the non-AE group.…”

“…Several studies have revealed that sore throat was the commonest presenting complaint 4 , 6–11 . However, this complaint was nonspecific and commonly expressed by patients with other disease entities.…”

“…Previous studies have reported a sensitivity of 38%–77% and a specificity of 76% for diagnosing epiglottitis through radiography of the lateral soft tissues of the neck 7 , 10 . Although lateral neck radiography is not a sensitive diagnostic tool, clinical physicians should clinically suspect AE when radiologic features indicative of a swollen epiglottis are present.…”

Pasteurella multocida Epiglottitis

“…13 However, one study showed that lateral radiography only had a sensitivity of 38% and specificity of 76% for diagnosing epiglottitis. 16 An ultrasound of the neck can also demonstrate an increased anteroposterior diameter of the epiglottis in epiglottitis and may aid in diagnosis. 17 Computed tomography is very accurate at diagnosing epiglottitis.…”

Acute epiglottitis from corrosive ingestion

“…Absence of radiological “thumb sign” should not rule out AE. [5] In a clinically unstable patient with suspected AE, clinical stabilization and airway securement should get priority over X-ray imaging of the neck.…”